Self Screening

The following questions are designed to help decide if our clinic suits your current needs. No one but you will see your answers.

What is your age?(Required)

Under 12 years old

12 to 18 years old

19 years and older

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Can you get the consent of a parent?(Required)

If you are between 12 and 19 years old, we are mandated to get parental consent before we can provide therapy.

Yes

No

It's complicated

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Are you seeking therapy only for yourself?(Required)

Yes, only for me

I would like to bring my partner

I would like to bring a dependent child under the age of 19

I would like to bring one or more other family members

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Can you afford $25 per session?(Required)

Due to overhead costs to keep the clinic running, we need to collect a small donation for each session.

Yes, I can afford a $25-$50 donation per session

No, I can not at this time

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Your current emotional state(Required)

Are you actively self-harming, suicidal, or in a state of extreme distress?

Yes

No

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Your substance use habits(Required)

Are you actively using substances that would interfere with your ability to be fully present during sessions?

Yes

No

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Your level of risk(Required)

Have you had a suicide attempt in the past 24 months?

Yes

No

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Mental health risks and supports(Required)

Do you have a mental health diagnosis that interferes with your daily functioning, and requires frequent monitoring by a Psychiatrist or medical practitioner?

Yes

No

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